Addressing threats to health care's core values, especially those stemming from concentration and abuse of power. Advocating for accountability, integrity, transparency, honesty and ethics in leadership and governance of health care.

Friday, February 03, 2006

More Trouble, But Also a Little Hope, in the OC

The stories about University of California - Irvine (UCI) Medical Center, located in Orange County, California, just keep on coming, but at least now there are some signs of progress.

We have posted often, most recently here, about the continuing problems at the medical center. A chronology of problems there going back over ten years appeared in the Orange County Register. In 1995 - UCI Center for Reproductive Health physicians were accused of stealing patients' eggs and implanting them in other women, one was convicted, two fled the country; 1997 - UCI closed its Organ and Tissue Bank after charges of poor record keeping and storage, also cancer patients were allegedly improperly charged for participation in clinical trials; 1999 - the Director of the UCI Willed Body Program was accused of selling body parts; 2005 - UCI shut down its liver tranplant program after Medicare found mismanagement, poor staffing, and poor surviva; 2006 - problems surface in bone marrow and kidney transplant program.

New Revelations

New problems at UCI keep surfacing.

Proposed rules changes by state regulators now threaten the ability of Dr Jagat Narula, Chairman of UCI' cardiology division, to remain in his job, according to the Los Angeles Times. It had been previously reported that neither Narula nor Associate Chairman Dr Mani Vannan have California medical licenses or US board certifications in cardiology (see our post here). The two had been practicing under a exemption "that allows visiting physicians to practice at teaching hospitals without a California medical license for as long as five years." Apparently this provision had never been intended to apply to physicians in leadership positions, and new regulations will make this intention explicit.

According to the Orange County Register, "a former UCI Medical Center anesthesiologist [Dr Glenn Provost] said in a lawsuit that he lost his job in 2003 because he complained about safety problems, including rushing patients too hastily into surgery to save money." "The lawsuit, filed in Orange County Superior Court in 2005, also alleges that Provost's job was eliminated shortly after he presented a faculty petition about safety issues to the head of anesthesiology." In response, Dr Peter Breen, the head of anesthesiology at UCI, said "quality patient care" is the department's goal, and that internal inquiries have found "no systemic problems affecting patient safety."

Beginnings of Reforms

On the other hand, in response to the multiple problems that are now very public, UCI is beginning to change how it operates, as are other institutions associated with it.

Dr Ralph Cygan, the suspended CEO of UCI Medical Center, resigned, according to the Orange County Register. The Dean of the Medical School Dr Thomas Cesario will now report to a Vice Chancellor for Health Sciences. UCI will also make "the ombudsman a full-time position, moving him to the medical center and instituting a corporate compliants processs to handle issues raised by concerned staff." UCI Chancellor Michael V Drake apologized to those "misled, confused or otherwise served poorly by the statements or actions of anyone representing the university." Apparently referring to allegations that Cygan and Cesario misled the United Network for Organ Sharing (UNOS) about whether UCI had on-site leadership of its liver transplant program, Drake said, "[this is] not what we want to do. We have an organization that works very hard to provide patient care .... What we want to do is work hard to continue to provide services and do everything we can to regain the public trust." He said problems at UCI "are a result in a breakdown in the application of the values that must drive every decision made at the medical center, the School of Medicine, and the entire UCI campus." On the other hand, Drake "didn't think administrators are to blame. 'I think it is a cultural issue. I think it is pervasive in the institution. I don't think it's management. This has to be a cultural overhaul.

Per the San Diego Union-Tribune, Dr Marquis Hart, a surgeon at UC - San Diego who had been commuting to UCI to perform transplants, was "forced ... to step down as director of the [UCSD] Abdominal Transplant Program because of concerns he misled national organ officials about taking charge of UC Irvine's troubled liver transplant program." Per the Los Angeles Times, the reason was "the university has concluded that UCI representatives were not wholly accurate in describing the surgical coverage for the UCI liver transplant program." UCSD Medical Center CEO Richard J. Liekweg said, "we must ensure that the director of our transplant program has the full confidence and support of the public and the regulatory agencies."

Finally UNOS, upset that it had learned very late that improvements promised by UCI leadership in its liver transplant program were not made, has instituted a series of reforms of its own operations, according to the Orange County Register. These include monitoring rates of organ refusals and of deaths on transplant waiting lists; prohibiting a surgeon from being a primary transplant surgeon at more than one program; requiring that hospitals notify UNOS of any negative actions taken against or reviews about them; setting stricter limits on corrective actions taken after reviews find problems in a program; and establishing a confidential communications line for patient complaints.

Comments

I believe it is encouraging that reforms are taking place in response to the problems at UCI. I could speculate that these reforms, coupled with those at the University of Medicine and Dentistry of New Jersey (UMDNJ) in response to the scandal there (see last post here), and at Roger Williams Medical Center (RWMC) in response to the scandal there (see last post here), might be the begininings of a trend. If nothing else, it is a little encouraging to see top managers apologizing for previous misdeeds (even by somebody else) and promising improvements. Of course, my little bit of hope is tempered by them qualifying their apologies, e.g., by remarks that administrators are not to blame.

Furthermore, considering the reforms proposed at various institutions begins to provide a framework for better governance of health care institutions (at least, of not-for-profit academic medical centers). For example, two of these institutions, UCI and RWMC, intend to appoint an individual (ombudsman or chief ethics officer) who can operate independently to react to complaints about mismanagement and unethical behavior. Maybe every large health care organization should have such an individual. Of course, having a chief ethics officer might suggest the need for an explicit code of ethics to which that officer can refer.

1 comment:

Anonymous
said...

According to documents filed with the Superior Court, County of Orange, UC Regents are fighting to enforce a $475,000 settlement of whistleblower Glenn Provost's wrongful termination suit all the way to the District Court of Appeals. Dr. Provost has alleged in court filings that he only signed the settlement agreement under threat of criminal prosecution for allegedly mooonlighting while working at UCI Medical Center. Provost also claims in court filings that he would never have accepted the $475,000 settlement absent the prospect of criminal prosecution, which could have resulted in the loss of his medical license. I wonder how much public money has been wasted by the Regents in their defense of Provost's civil suit and in defending Peter Breen from the Medical Board action that recently resulted in Breen being ordered to take eithics and record-keeping courses.

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